Preoperative serum cystatin C combined with dipstick proteinuria predicts acute kidney injury after cardiac surgery
10.3760/cma.j.issn.1001-4497.2016.10.008
- VernacularTitle:术前血清胱抑素C联合尿蛋白半定量测定早期预测心脏手术后急性肾损伤
- Author:
Xudong WANG
;
Miaolin CHE
;
Bo XIE
;
Song XUE
- Keywords:
Cardiac surgical procedures;
Kidney/injuries;
Biomarkers;
Forecasting
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2016;32(10):612-615
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate serum cystatin C combined with dipstick proteinuria as early markers to predict AKI available before surgery.Methods We prospectively followed 616 patients undergoing cardiac surgery.Univariate as well as multivariate regression was performed.Cystatin C combined with dipstick proteinuria before surgery was assessed for its' predictive value of AKI using receiver operator characteristic (ROC) curves.Results Patients in higher cystatin C quartiles were older(P ＜ 0.001),more often to have heavy proteinuria(P =0.021),hyperuricemia(P ＜ 0.001),heart failure(P ＜ 0.001)and recent MI (P =0.002).Those with heavy proteinuria were more often to have diabetes mellitus (DM) (P =0.010),hyperuricemia (P =0.043),worse cardiac function (P ＜ 0.001),higher creatinine levels (P ＜ 0.001) and lower eGFR levels (P ＜0.001).In a multiple logistic regression model,preoperative heavy proteinuria(OR =3.14) and preoperative cystatin C quartiles each associated with an increased odds of AKI,independent of advanced age (OR =1.04),hypertension (OR =1.88) and combined surgery(OR =3.47).The risk for adverse outcomes such as postoperative AKI,persistent AKI,severe AKI,dialysis and mortality were highest in patients with highest quartile of cystatin C(P ＜0.05,respectively) and heavy proteinuria (P ＜ 0.05,respectively).The area under the ROC curve(AUCs) for preoperative cystatin C combined with proteinuria to detect AKI,persistent AKI and severe AKI were 0.695,0.753 and 0.718,P ＜0.001 respectively.Conclusion These data suggest that preoperative serum cystatin C combined with dipstick proteinuria may improve prediction of AKI among patients undergoing cardiac surgery.
